Health care falling victim to turf wars

He goes on to add, “Australia has a world-class health system. To keep it world class, we need world’s best solutions, not second best.”

The introduction of role substitution has not been sudden, or forced. It has been steadily evolving, particularly within the public sector where it has been seen as safe and expedient for a nurse and allied health workers to undertake an expanding number of tasks.

And the AMA is correct when it represents Australia as having a world-class system. That is an incontestable fact - but equally incontestable is that role and task substitution have been a widespread trend within our health sector for years.

Section 8 of the Productivity Commission’s report lists areas of practice that professionals other than doctors are already undertaking.

From that list you can draw countless individual tasks formerly done by medical practitioners, now done by others: it’s a strong feature of our world-class system already.

The report goes on to list other areas that also may lend themselves to task or role substitution. Given the extent of role and task substitution that we are more than happy to live with today, the quality and safety argument starts to look a little less potent.

The argument is further diluted when one considers the AMA supports the notion of “task delegation”, but opposes “task substitution”. The definition doesn’t alter the fact that non-medical people are doing the task.

In terms of getting the job done, however you describe it, the outcome is the same. One of the differences here though is that “substitution” is potentially linked to MBS funding while “delegation” is not.

It would be churlish to suggest this debate is all about money. But it would also be naïve to accept the argument that it is solely about quality and safety, given the realities of our system today.

There is clearly an unmet need for healthcare services in Australia, and ageing will exacerbate the demand. It is therefore time to seek out a new paradigm for delivering health services under the weight of that unmet need.

The Australian Government has the report before it right now. The recommendations offer some possible paths towards safe change in the face of significant workforce challenges, and deserve serious consideration and prompt action.

The Australian public deserves better than to be asked to stand by and watch while the professions engage in what is essentially little more than a turf war.